Share this:

When is an endocrinologist necessary over a Primary Care Physician?

Posted by @retiredteacher, Sep 4, 2017

I was diagnosed with diabetes 2 about one year and a half ago. My PCP sent me a letter that I had diabetes 2. She didn’t have any information and never being a sickly person, I had no idea what to do. The PCP admitted diabetes was not her area. Where we live there are few specialists and a hospital like a clinic. I found the one endocrinologist (ready to retire) who sees patients one day a week, maybe. He had no answers since my numbers were not high, but I guess he felt obligated to do something so he asked about throwing medicines at the problem. I told him I didn’t see the reason for meds when I was just barely over normal. I told him I decided not to take anything, but to control with diet. I have read too many horror stories about Metformin and ads all over TV about other meds that have horrid side effects. So that’s what I have done for the time I’ve had this disease. I haven’t seen any change in numbers—higher in the morning and dropping during the day is typical. Blood checks in A.M and three hours after lunch. Sometimes higher; sometimes lower.

I’m wondering if I need to keep seeing the endo. when he’s doing the same thing the PCP does. For all practical purposes I am my own dr. There is no changing doctors where I live. One won’t take another’s patient. Since the elder endo. has basically retired except for once a week, he’s not available for anything except on Monday, if he’s in the office.

I know other people don’t have such poor health care available, but it’s that way where I live. I am thinking that since the endo and the PCP do the same tests and know the same that there is no point in seeing the endo. Seeing the PCP is enough, and she can run the numbers.

Any opinions? Thanks.

retiredteacher

REPLY

I am T2 diabetic, and I see an endo. He is trying different medication for me, but I take a minimal amount of Lantus, long acting insulin. Once every day I take 13 units. That’s barely anything and it works for me. I lost 85 lbs 3+ years ago and my blood sugar improved tremendously. I was taking 132 units of 2 different kinds of insulin before weight loss. The reason I take insulin is I reacted badly to Metfomin, and several other meds. Also, my mother died from pancreatic cancer so I decided it wasn’t a good idea to stimulate my pancreas to produce more insulin. I have NO side effects from insulin.

As far as your morning blood sugar being high, that is a reaction called “dawn effect. One thing you can do is to have 1/2 a peanut butter sandwich before bed. The dawn effect happens because your body produces extra sugar around 3 am or so, to prepare you to be active in the morning, but your pancreas can’t handle it. I probably didn’t explain it well, so Google it. The sandwich the night before helps your blood sugar to be up enough at 3 am that you don’t need to produce extra sugar. Your blood sugar should be better in the morning. If you read a lot about T2 diabetes online at reputable sites, you can learn almost every thing you need to know about it. I’ve had T2 for about 15 years now. I’ll be happy to answer any questions you may have, or let you know if you need to talk to a doctor. By the way, I’ve only recently had an endocrinologist. Ive always used my PCP. But, you may want to travel to get an overview by an endocrinologist at first, and then change to your PCP later. Most hospitals provide Diabetes Education classes that I HIGHLY recommend you attend, maybe via computer or Skype if that’s all you can do. I take the classes every 4 years or so as a reminder, but also, new drugs and research change protocols every so often. I always learn new things from the classes. Last, if you’re overweight, get rid of your excess weight. Sometimes that’s all you need to do in order for your T2 to go into remission. Good luck in learning what you can do to keep things under control. Gail B Ledesma

Thank you for your suggestion. I am familiar with the dawn effect. I have researched this disease since I was told I have it. I have never taken any meds and intend not to. I think for me, since I am on the line or under with my numbers, I will continue to experiment with different foods. Everyone is different, and what works for me, may not work for everyone. I wish there was a blanket diet or med that would be effective for everyone, but that’s not the way it works. The endo. I have been seeing has never mentioned anything other than numbers for A.M and P.M. He said I had everything under control. My blood panels and profiles were all in normal range, so he seemed to think I really didn’t need to be there. That’s why I asked about just letting my PCP do the bloodwork. She’s been running everything except the A1c, but she did that before I started with the endo. I see no reason to see both, and they don’t give me any help. I have researched every day and know the information, so that’s why I said I am my own dr. Unless I had some drastic change in all my profiles, I think once a year with PCP is sufficient. I am not sickly and have not been ill in years. I am an older senior, so I don’t do any strenuous exercise. I try to eat what I find as healthy and I check labels, so I am fortunate. There are many people on this site that have numerous illnesses and are in the hospital often and in different doctors’ offices often. I am sorry they have to go through all of that. I have been to the endo twice for blood panels in 2017 and the PCP once for her bloodwork. No sickness—routine visits.
I may try the peanut butter, although I limit bread, so I hesitate to have a sandwich.

Thanks again.

retiredteacher

@retiredteacher I think whether you see an endo or a PCP is really dependent on how much confidence you have in your PCP in that area. I initially used the PCP who diagnosed me with diabetes and I felt comfortable with her because diabetes runs in her family. Despite being petite she fully expects to have it herself at some point. Then she dropped her private practice to become a hosptalist (better for her since has young children) and I had to find a new doctor. At that point I did decide to see an endo and he was great. I was on metformin for a while but after a short time he took me off of it. My A1c was really excellent. I lost him because he moved to another town so now I am using my current PCP for my diabetes and hypothyroid. I just do not feel he is as knowledgeable so I am considering changing back to an endo. I have even considered going back to my former endo, he is only about an hour away and I only go two times a year.
I found the peanut butter thing interesting. My morning number is not bad but after my transplant when I was on a higher dose of prednisone it got quite high so I was put on insulin. That was too much for me though, my morning numbers went as low as 40. So it was reduced and then stopped.
Hmm,now I have an excuse to have some peanut butter before bed.
JK

@contentandwell

@retiredteacher I think whether you see an endo or a PCP is really dependent on how much confidence you have in your PCP in that area. I initially used the PCP who diagnosed me with diabetes and I felt comfortable with her because diabetes runs in her family. Despite being petite she fully expects to have it herself at some point. Then she dropped her private practice to become a hosptalist (better for her since has young children) and I had to find a new doctor. At that point I did decide to see an endo and he was great. I was on metformin for a while but after a short time he took me off of it. My A1c was really excellent. I lost him because he moved to another town so now I am using my current PCP for my diabetes and hypothyroid. I just do not feel he is as knowledgeable so I am considering changing back to an endo. I have even considered going back to my former endo, he is only about an hour away and I only go two times a year.
I found the peanut butter thing interesting. My morning number is not bad but after my transplant when I was on a higher dose of prednisone it got quite high so I was put on insulin. That was too much for me though, my morning numbers went as low as 40. So it was reduced and then stopped.
Hmm,now I have an excuse to have some peanut butter before bed.
JK

Jump to this post

Thanks for your response @contentandwell. I think maybe it all boils down to trusting the doctors and being assured that they know what they are talking about and not just throwing different meds so they don’t have to bother with actually talking to the patient and not trying everything Big Pharma has on the market.
She is the one that told me everything was in range, but when I looked at the printout there were several outside the range. She never said anything. Then she sent me the letter with “You have diabetes!” No instructions, no info. on what to do. All she said was get a blood meter and check your numbers. The end for her on the subject. That’s when I started researching and purchased the Mayo books and read everything I could find. I went to the endo. and he’s a nice old-fashioned dr. He will sit and talk but has no answers. He’s practically closed his practice except he has two PA’s now to collect the money and take blood pressure. So I am my own dr. I take no meds for diabetes. I have been trying to follow foods that are suggested, but I have gained weight doing that. I’m just taking care of myself as best I can by researching on the internet.
I tried peanut butter, but that did not work for me. I’ll look for something else that might work. I had oatmeal sprinkled with a few nuts and that didn’t work either. So I’ll keep trying.
I am glad you are having good reports.

retiredteacher

@contentandwell

@retiredteacher I think whether you see an endo or a PCP is really dependent on how much confidence you have in your PCP in that area. I initially used the PCP who diagnosed me with diabetes and I felt comfortable with her because diabetes runs in her family. Despite being petite she fully expects to have it herself at some point. Then she dropped her private practice to become a hosptalist (better for her since has young children) and I had to find a new doctor. At that point I did decide to see an endo and he was great. I was on metformin for a while but after a short time he took me off of it. My A1c was really excellent. I lost him because he moved to another town so now I am using my current PCP for my diabetes and hypothyroid. I just do not feel he is as knowledgeable so I am considering changing back to an endo. I have even considered going back to my former endo, he is only about an hour away and I only go two times a year.
I found the peanut butter thing interesting. My morning number is not bad but after my transplant when I was on a higher dose of prednisone it got quite high so I was put on insulin. That was too much for me though, my morning numbers went as low as 40. So it was reduced and then stopped.
Hmm,now I have an excuse to have some peanut butter before bed.
JK

Jump to this post

@retiredteacher My advice is to stay away from grains even though the information says the are ok to eat. They shoot my blood sugar very high. I’ve had T2 diabetes for 15 years now, and have figured out what I can eat and what I can’t. I have found out
1. I must count my carbohydrates. Eat nothing with more than 15 gr of carbohydrates, and keep sugar grams 10 gr or less.
2. I can only have about 50 gr of carbohydrates total each day. That includes vegetables, fruit, nuts, grains, milk, etc.
3. Walk or do some kind of exercise for 30 minutes a day.
4. Stay away from all sodas, diet or regular.
5. No fruit juice unless you’re having a hypoglycemic attack, which you shouldn’t have since you arent taking meds.
6. Find low glycemic fruit, i.e. no bananas or only 1/2 if you eat bananas. Strawberries, blueberries, almost all berries in moderation.
7. One serving is 1/2 cup. That’s 1 serving of vegetables or fruits. Keep meats lean and 4 oz is enough. That’s the size of the palm of your hand.
8. When I have carbohydrates, I also have something with fat and protein with them. The fat keeps my blood sugar more steady. It’s a balancing act. Peanut butter works as a snack with it on celery sticks. I also eat nuts (1/4 cup), Greek yogurt, and cottage cheese. Yogurt & cottage cheese are low in carbohydrates (get the 4%–not the low fat) and high in protein.

Good luck with managing your blood sugar. It will not always work even if you do everything right, so expect days where your blood sugar is up for no apparent reason. Just stick with the routine anyway and it will come back down.

@contentandwell

@retiredteacher I think whether you see an endo or a PCP is really dependent on how much confidence you have in your PCP in that area. I initially used the PCP who diagnosed me with diabetes and I felt comfortable with her because diabetes runs in her family. Despite being petite she fully expects to have it herself at some point. Then she dropped her private practice to become a hosptalist (better for her since has young children) and I had to find a new doctor. At that point I did decide to see an endo and he was great. I was on metformin for a while but after a short time he took me off of it. My A1c was really excellent. I lost him because he moved to another town so now I am using my current PCP for my diabetes and hypothyroid. I just do not feel he is as knowledgeable so I am considering changing back to an endo. I have even considered going back to my former endo, he is only about an hour away and I only go two times a year.
I found the peanut butter thing interesting. My morning number is not bad but after my transplant when I was on a higher dose of prednisone it got quite high so I was put on insulin. That was too much for me though, my morning numbers went as low as 40. So it was reduced and then stopped.
Hmm,now I have an excuse to have some peanut butter before bed.
JK

Jump to this post

Thanks for all the good info. Some of it I can do and other items not. Everyone is different is the saying I’ve heard over and over. Basically, diabetes is a horrible disease and a horrible diet. I have eaten so many green beans, turnips, kale, broccoli and the like that I think I am turning into a green vegetable.

You are right. Whether I follow the diet or eat something not on the list, it doesn’t seem to matter. I’m still trying to decide if I will go to the endo. or just let the PCP do the blood work panels. As long as there are computers, they don’t have to know much to read a printout.

Appreciate your sharing.

retredteacher

@contentandwell

@retiredteacher I think whether you see an endo or a PCP is really dependent on how much confidence you have in your PCP in that area. I initially used the PCP who diagnosed me with diabetes and I felt comfortable with her because diabetes runs in her family. Despite being petite she fully expects to have it herself at some point. Then she dropped her private practice to become a hosptalist (better for her since has young children) and I had to find a new doctor. At that point I did decide to see an endo and he was great. I was on metformin for a while but after a short time he took me off of it. My A1c was really excellent. I lost him because he moved to another town so now I am using my current PCP for my diabetes and hypothyroid. I just do not feel he is as knowledgeable so I am considering changing back to an endo. I have even considered going back to my former endo, he is only about an hour away and I only go two times a year.
I found the peanut butter thing interesting. My morning number is not bad but after my transplant when I was on a higher dose of prednisone it got quite high so I was put on insulin. That was too much for me though, my morning numbers went as low as 40. So it was reduced and then stopped.
Hmm,now I have an excuse to have some peanut butter before bed.
JK

Jump to this post

@gailb Only 50 gm of carbs a day is ridiculously low. I can’t even imagine what you must eat. I was told 45 per meal and a couple of snacks of about 15 each. I find I tend to go higher in the morning and then lower in the evening.
JK

@contentandwell

@retiredteacher I think whether you see an endo or a PCP is really dependent on how much confidence you have in your PCP in that area. I initially used the PCP who diagnosed me with diabetes and I felt comfortable with her because diabetes runs in her family. Despite being petite she fully expects to have it herself at some point. Then she dropped her private practice to become a hosptalist (better for her since has young children) and I had to find a new doctor. At that point I did decide to see an endo and he was great. I was on metformin for a while but after a short time he took me off of it. My A1c was really excellent. I lost him because he moved to another town so now I am using my current PCP for my diabetes and hypothyroid. I just do not feel he is as knowledgeable so I am considering changing back to an endo. I have even considered going back to my former endo, he is only about an hour away and I only go two times a year.
I found the peanut butter thing interesting. My morning number is not bad but after my transplant when I was on a higher dose of prednisone it got quite high so I was put on insulin. That was too much for me though, my morning numbers went as low as 40. So it was reduced and then stopped.
Hmm,now I have an excuse to have some peanut butter before bed.
JK

Jump to this post

I agree that 50 grams of carbs total and most of the other low numbers are not foods for three meals a day, at least not for me. Even the dietician in training and the Mayo diet call for more than that and the plate division pyramid says more than that too. That’s what I was told. So once again what works for one doesn’t work for someone else. If I eat the wrong food, my blood numbers go up; but if I don’t eat enough; they really go up. I was told it’s better to eat the wrong food than to skip eating. I have found myself in situations where there is no healthy, low count anything (celebrations, tailgating, dinner out, etc.) so I eat what is prepared and put on the table. I know my numbers will go up. The next day I get back on the Diabetes food wagon. I was brought up not to discuss sickness in public gatherings; people don’t want to hear that and it also distances people who are well and want to have a good time. They don’t want to be dragged down by having to say, “How awful or You poor thing.” Then they go on having fun and you are left alone as if you have the plague. Talking to someone on this forum is one thing since we are all dealing with the disease, but ruining a party or a dinner or a fun gathering is just not appropriate for me. So we each do what works, and I keep experimenting to see what I can add to my food list.

retiredteacher

@gailb I am T2 and also follow a diet much like yours. My blood sugar tends to spike easily with any higher carbs. My A1C has been 5.5, 5.6 for the last 9 months or so and I generally do not feel deprived by these foods. It is all a balancing act, I figured that out early on. Thanks for your input.

@contentandwell

@retiredteacher I think whether you see an endo or a PCP is really dependent on how much confidence you have in your PCP in that area. I initially used the PCP who diagnosed me with diabetes and I felt comfortable with her because diabetes runs in her family. Despite being petite she fully expects to have it herself at some point. Then she dropped her private practice to become a hosptalist (better for her since has young children) and I had to find a new doctor. At that point I did decide to see an endo and he was great. I was on metformin for a while but after a short time he took me off of it. My A1c was really excellent. I lost him because he moved to another town so now I am using my current PCP for my diabetes and hypothyroid. I just do not feel he is as knowledgeable so I am considering changing back to an endo. I have even considered going back to my former endo, he is only about an hour away and I only go two times a year.
I found the peanut butter thing interesting. My morning number is not bad but after my transplant when I was on a higher dose of prednisone it got quite high so I was put on insulin. That was too much for me though, my morning numbers went as low as 40. So it was reduced and then stopped.
Hmm,now I have an excuse to have some peanut butter before bed.
JK

Jump to this post

@retiredteacher I admire your attitude, you really are doing well with your restrictions. Are you active? That of course helps a lot they say. I myself have not really compared my numbers from when I was active to now when I am pretty active, I will be interested in seeing my A1c the next time I have that type of appointment.
I agree that you do not want to discuss sickness at public gatherings and eating can be a problem. I was at one of those recently and did eat things I would not usually eat. I paid for that for three days afterwards.
JK

@contentandwell

@retiredteacher I think whether you see an endo or a PCP is really dependent on how much confidence you have in your PCP in that area. I initially used the PCP who diagnosed me with diabetes and I felt comfortable with her because diabetes runs in her family. Despite being petite she fully expects to have it herself at some point. Then she dropped her private practice to become a hosptalist (better for her since has young children) and I had to find a new doctor. At that point I did decide to see an endo and he was great. I was on metformin for a while but after a short time he took me off of it. My A1c was really excellent. I lost him because he moved to another town so now I am using my current PCP for my diabetes and hypothyroid. I just do not feel he is as knowledgeable so I am considering changing back to an endo. I have even considered going back to my former endo, he is only about an hour away and I only go two times a year.
I found the peanut butter thing interesting. My morning number is not bad but after my transplant when I was on a higher dose of prednisone it got quite high so I was put on insulin. That was too much for me though, my morning numbers went as low as 40. So it was reduced and then stopped.
Hmm,now I have an excuse to have some peanut butter before bed.
JK

Jump to this post

@retiredteacher oops, I meant to say from when I was inactive to now, being active. They so say activity helps to bring your A1c down.
JK

An endocrinologist should be part of your team. I see one every 3 months, she’s the one that does the dosing, makes sure you don’t have neuropathy. The primary care physician then follows the treatment of the endo doctor. When this happens, you may only see your endo about once every 6 months, unless there’s a problem.

@contentandwell

@retiredteacher I think whether you see an endo or a PCP is really dependent on how much confidence you have in your PCP in that area. I initially used the PCP who diagnosed me with diabetes and I felt comfortable with her because diabetes runs in her family. Despite being petite she fully expects to have it herself at some point. Then she dropped her private practice to become a hosptalist (better for her since has young children) and I had to find a new doctor. At that point I did decide to see an endo and he was great. I was on metformin for a while but after a short time he took me off of it. My A1c was really excellent. I lost him because he moved to another town so now I am using my current PCP for my diabetes and hypothyroid. I just do not feel he is as knowledgeable so I am considering changing back to an endo. I have even considered going back to my former endo, he is only about an hour away and I only go two times a year.
I found the peanut butter thing interesting. My morning number is not bad but after my transplant when I was on a higher dose of prednisone it got quite high so I was put on insulin. That was too much for me though, my morning numbers went as low as 40. So it was reduced and then stopped.
Hmm,now I have an excuse to have some peanut butter before bed.
JK

Jump to this post

When I was young, working, and going all the time, I also was taking aerobic classes, swimming, riding my horses, walking, and generally on the go. I was skinny all my life and never had any fat. As I got older and had to deal with a number of personal problems, I gained weight. Since I retired, I do not do any organized exercise. I have a bad knee, so I use a cane and the exercise I get is what I do walking around in the house or going to the grocery store and the like. I have a tread mill, but the knee gets worse when I walk on it. I walked on the tread mill every day for one month, to see if I could tell any difference; I didn’t see that it helped and I gained weight! I thought I would lose, but it didn’t happen. So that’s about as active as I get. I know I should have a schedule for exercise, but I don’t. I count the walking I do as enough for someone my old age. I don’t drink alcohol of any kind; I don’t smoke. I try to eat as healthy as I can and monitor my blood. Except for being labeled a diabetic, which I hate, I feel pretty good for someone my age. My A1C is at 6.0 and my average blood draw for A.M. and P.M. is 120. So unless something catastrophic happens, I am doing what I can and what is okay for me.

retiredteacher

I was diagnosed T2 about a year and a half ago and haven’t seen an endo. I feel fortunate that I am doing well with my PCP, pharmacy therapist (insulin dosage) and hospital educators. I do understand to expect changes with time. My insulin is 10 units twice daily. I’m hesitant of Metformin because I previously had acute kidney failure and although I’m told kidneys are normal now, very concerned about those side effects of Metformin.

@jeya

An endocrinologist should be part of your team. I see one every 3 months, she’s the one that does the dosing, makes sure you don’t have neuropathy. The primary care physician then follows the treatment of the endo doctor. When this happens, you may only see your endo about once every 6 months, unless there’s a problem.

Jump to this post

@jeya, in an ideal situation I would have a team, but there is no coordination or cooperation between the PCP and the endo. I don’t have a team; there’s nothing like that where I live. It’s a strange situation, but my team is my husband, the internet research I do, the books I read about diabetes, and me. That’s why I always say I am my own doctor. The medical people don’t exchange info. from what I can see.
With my endo. getting ready to retire, I have just about decided to see my PCP; she can do the blood panels, and that’s all I need her for. If I had anything more, I’d have to travel to get to a specialist. Sad but true.

retiredteacher

Please login or register to post a reply.